Sleep: Considerations in the Patient With Psychiatric Disorders. Rafael Pelayo, MD. Topics. Definition of insomnia Epidemiology of insomnia with psychiatric disorders Specific features of sleep and sleep disturbances in psychiatric disorders

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Sleep: Considerations in the Patient With Psychiatric Disorders

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Insomnia: Definition

National Institutes of Health State of the Science Conference Statement

Manifestations and Management Of Chronic Insomnia in Adults

Chronic insomnia is a major public health problem affecting millions of individuals, along with their families and communities

Little is known about the mechanisms, causes, clinical course, comorbidities, and consequences of chronic insomnia

Evidence supports the efficacy of cognitive-behavioral therapy and benzodiazepine receptor agonists in the treatment of this disorder

Very little evidence supports the efficacy of other treatments, despite their widespread use

Even treatments that have been systematically evaluated, the panel is concerned about the mismatch between the potential lifelong nature of this illness and the longest clinical trials, which have lasted 1 year or less

A substantial public and private research effort is warranted, including the development of research tools and the conduct of longitudinal studies and randomized clinical trials

There is a major need for educational programs directed at physicians, healthcare providers, and the public

National Institutes of Health. Sleep. 2005;28:1049-1057.

National Institutes of Health State of the Science Conference Statement (cont’d)

Manifestations and management of chronic

insomnia in adults

Primary insomnia

Implies no other cause of sleep disturbance

Comorbid insomnia

Formerly known as secondary insomnia

Limited understanding of pathophysiology and direction of causality

Use of term “secondary” leads to undertreatment

National Institutes of Health. Sleep. 2005;28:1049-1057.

National Institutes of Health State of the Science Conference Statement (cont’d)

Manifestations and management of chronic

insomnia in adults

Some evidence suggests high healthcare utilization

Direct and indirect costs of chronic insomnia estimated as tens of billions of dollars annually

Relation of Dreams to Waking Concerns

To test that dreams are influenced by the presleep waking emotional concerns of the sleeper and have an effect on waking adaptation, 20 depressed and 10 control subjects, who were all going through a divorce, were enrolled in a repeated measures study lasting 5 months

A Current Concerns test was administered on 3 occasions before nights when every REM period was interrupted to record recalled mental content

The degree of waking concern about the ex-spouse correlated significantly with the number of dreams in which the former partner appeared as a dream character

Those who were in remission at the follow-up evaluation had a higher percentage of well-developed dreams than those who remained depressed

Dreams of the former spouse reported by those in remission differed from those who remained depressed in the expression of dream affect and in the within-dream linkage among units of associated memory material

Dreams of the former spouse that are reported by those who are not in remission lack affect and connection to other memories